Lateral Release of the Knee

Surgery to Realign the Kneecap

lateral release
A lateral release is typically performed by arthroscopic surgery. Javier Larrea / Getty Images

A lateral release is a surgical procedure on the knee used to realign the kneecap (also called the patella).  The lateral release is performed as an arthroscopic knee surgery, and can be performed as an outpatient.  The usual reason to perform a lateral release is because of a dislocating or subluxing kneecap that is causing pain.

Patellar Movement

The kneecap moves up and down in a groove on the end of the thigh bone as the knee bends.

  In some patients, the kneecap is abnormally pulled towards the outside of its groove. When the kneecap does not slide well within the groove, cartilage irritation and pain can result. There are several causes of patellar maltracking (the name given to the kneecap being pulled to the outside), and the most common is tight tissue attached to the outside of the kneecap (the lateral retinaculum).

When your doctor assesses your kneecap problems, he or she will look for several underlying problems with the mechanics of the kneecap. Patellar tilt is the angle of the kneecap, and whether or not it is being excessively tilted by a tight retinaculum. The other is patellar subluxation, which is when the kneecap is being pulled outside of the groove due to malalignment.

Lateral release is best for patient with excessive patellar tilt. When the lateral retinaculum is too tight, it can act as a tether to the kneecap.

A lateral release is a procedure performed to cut through this tight retinaculum, and allow the kneecap to sit properly within its groove.

When To Perform a Lateral Release

A lateral release is successful when performed in the right patient. For many years, doctors were performing this procedure too commonly, and some patients did not find relief.

As we have gained experience with this problem, surgeons have become better at selecting which patients are likely to benefit from a lateral release.

The good news for patients, is that in most all cases, a tight lateral retinaculum can be successfully treated with nonsurgical stretching and rehabilitation.  For this reason, a lateral release should only be considered when patients have failed extensive efforts to address this problem through formal physical therapy. 

In addition, patients who have a kneecap dislocation often require a more extensive surgical procedure to address their condition.  There are a number of different surgical procedures to address kneecap dislocations including ligament reconstruction, bone realignment, and others.  The critical piece to finding success with treatment is to perform the right surgical procedure for each individual situation.

Complications of Lateral Release

The most common side effect of a lateral release is bleeding into the knee; this can lead to pain and swelling.

Other complications include infection, and scar tissue formation.  One of the most difficult aspects of surgery is ensuring the ligaments are released sufficiently to address the alignment issue, but not loosening the ligaments so much that the kneecap becomes unstable and pulled to the inside of the knee (medial subluxation).

Sources:

Post WR. "Anterior knee pain: diagnosis and treatment" J Am Acad Orthop Surg. 2005 Dec;13(8):534-43.

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